Case Report
The Impact of Gut Microbiota Modulation on Bone Health and Rheumatoid Arthritis: A Case Report and Literature Review
Harpreet Kour1* and Shrihari L Kulkarni2
1Department of Physiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India.
2Department of Orthopaedics, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India.
2Department of Orthopaedics, SDM College of Medical Sciences and Hospital, Shri Dharmasthala Manjunatheshwara University, Dharwad, Karnataka, India.
*Corresponding author:Harpreet Kour, Department of Physiology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India. E-mail Id: harpreetkour.kour@gmail.com
Article Information:Submission: 18/10/2025; Accepted: 12/11/2025; Published: 14/11/2025
Copyright: © 2025 Kour H, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The gut-bone axis represents a novel paradigm in which gut microbiota influences bone metabolism and systemic inflammation. Dysbiosis has been implicated in the pathogenesis of rheumatoid arthritis (RA), suggesting that microbiome-targeted therapies could offer adjunct benefits.
Case Presentation: A 52-year-old female presented with seropositive RA and concomitant irritable bowel syndrome (IBS). Stool analysis confirmed gut dysbiosis, characterized by an overgrowth of Prevotella copri and reduced commensal Lactobacillus and Bifidobacterium. In addition to initiating standard pharmacological therapy (methotrexate and adalimumab), a targeted microbiome modulation regimen was introduced, comprising a daily probiotic (Lactobacillus reuteri, 1×10⁹ CFU) and prebiotic (inulin, 10g). After three months of combined therapy, the patient reported significant improvements in joint pain, stiffness, and gastrointestinal symptoms. Objective biomarkers showed marked reduction: CRP decreased from 12 mg/L to 3.2 mg/L, IL-6 from 8.5 pg/ mL to 2.1 pg/mL, rheumatoid factor (RF) decreased from 58 IU/mL to 32 IU/mL, and anti-citrullinated protein antibody (ACPA) levels decreased from 145 U/ mL to 95 U/mL.
Conclusion: This case demonstrates significant clinical and serological improvement in a patient with RA following a combined pharmacological and microbiome-targeted intervention. It provides supportive evidence for the role of the gut-joint axis in RA and suggests that probiotics and prebiotics may be a beneficial adjunct to conventional therapy, warranting further investigation in controlled trials.
Case Presentation: A 52-year-old female presented with seropositive RA and concomitant irritable bowel syndrome (IBS). Stool analysis confirmed gut dysbiosis, characterized by an overgrowth of Prevotella copri and reduced commensal Lactobacillus and Bifidobacterium. In addition to initiating standard pharmacological therapy (methotrexate and adalimumab), a targeted microbiome modulation regimen was introduced, comprising a daily probiotic (Lactobacillus reuteri, 1×10⁹ CFU) and prebiotic (inulin, 10g). After three months of combined therapy, the patient reported significant improvements in joint pain, stiffness, and gastrointestinal symptoms. Objective biomarkers showed marked reduction: CRP decreased from 12 mg/L to 3.2 mg/L, IL-6 from 8.5 pg/ mL to 2.1 pg/mL, rheumatoid factor (RF) decreased from 58 IU/mL to 32 IU/mL, and anti-citrullinated protein antibody (ACPA) levels decreased from 145 U/ mL to 95 U/mL.
Conclusion: This case demonstrates significant clinical and serological improvement in a patient with RA following a combined pharmacological and microbiome-targeted intervention. It provides supportive evidence for the role of the gut-joint axis in RA and suggests that probiotics and prebiotics may be a beneficial adjunct to conventional therapy, warranting further investigation in controlled trials.
Keywords:Gut Microbiota; Rheumatoid Arthritis; Dysbiosis; Probiotics; Prebiotics; Gut-Bone Axis; Prevotella copri; Lactobacillus reuteri